Infestations and chronic infections in foreign pediatric patients with burns: is there a role for specific protocols?

Infestations by parasites such as Mycobacterium tuberculosis and other viral infections are common in third world countries. Consequently, the admission of a significant number of foreign patients to burn centers in the United States may pose new problems, not only for inpatients but also for health care workers. To document infestations in patients from third world countries and to determine the need for specific protocols, we studied 62 consecutive foreign patients admitted to our pediatric burn reconstruction service between July 1997 and December 1998. All patients were evaluated with chest X-ray, hemogram with differential count, clinical and laboratory nutritional assessment, and skin test for tuberculosis, and stool samples were evaluated for ova and parasites. No pathologic findings were seen on chest radiographs. Only 1 patient had a positive skin test for tuberculosis, as a result of previous bacille Calmette-Guérin vaccine. Yet, 10 patients (16%) had positive stool cultures for ova and parasites that contained 29 isolates. The most frequently identified organism was Blastocystis hominis. All amoebas identified were nonpathogenic according to Centers for Disease Control criteria. Ascaris lumbricoides and 1 case of cysticercosis were found. None of the patients with parasites had clinical manifestations of parasitosis or chronic infections. However, parasite infestations had a positive correlation with eosinophilia, altered nutritional status, and altered mean corpuscular hemoglobin concentration, as defined by multiple linear regression. Although foreign patients admitted to burn centers from third world countries have a low rate of infestations, patients at risk can be identified by laboratory findings and studies of nutritional status. Simple hand washing prevents the spread of disease and protects health providers.